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Please print or type.(Form designed for use on elite(12-pitch)typewriter.). Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page'of 3 rJnergenq Response Phone 4.Manifest Tracking Number <br /> � -I JJK <br /> WASTE MANIFEST ; . ?+: I `.. f <br /> 5.Generator's Name and Mailing Address. Generator's Site Address(if different than mailing acdress) <br /> x "cn <br /> Generator's Phone: <br /> 6.Trapspotte}1.Crompany Nr1^le U.S.EPA IQ Number <br /> ., <br /> j� <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.De4ipjed �Ih Name, Si(eAddress,rte.!.:'•:... _ . J.S.EPA ID Ncmber <br /> `3:.f u vl. w'f!'s I IOU'V,,.A•'&`I.M`!T, <br /> Faculty's Phone: <br /> 9a, 9b.U.S.DOT Description(Including Proper Stripping Name,Hazam Class,ID Number 10 Conlaine•s 11.Total 12.Unit 13'Haste Codas <br /> HM and Packing Group(if any)) No Type Quantity WtNcl. <br /> Ir- <br /> 3 :^ <br /> Z 2. F-E <br /> 3. FEB 17 2016 <br /> 4. ` <br /> EALT-I n;:04PT1IipCNI <br /> 14.Specral.Handling Instructions and Additional Information <br /> V�Y <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that toe contents of this consignment are fu.ly and accurately described above by the proper shipping name,and are classified,packages, <br /> marked and labeledlplecareed,and are in all respects it proper condition for transport according to a*Gab a:ntemat.onaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certiy that the contents of this consignment conform to fne terms of the attached EPAAckno-Aledgment of Consent <br /> I certify that the waste minimlzaton statement iden5fied in 40 C"R 262.27(a)(f I am a large quartrly generator)or(p)(dl am a small quantity generator)is true. <br /> GenQlatoesIOfferoes Printed/Typed Name Signature Month Day Vear <br /> -j 16.International Shipments <br /> ' <br /> p ❑Import to U.S. C Expo-t from U.S. Port of entrylexit - <br /> Transporter signature(for exports only): Date e ong U.S.: <br /> w 17.Transporter Acknowledgment of ReoeiD;o"Uaterials <br /> Transporter 1 Printed/Typed Name Signature y Month Day Year <br /> ZZ Transporter 2 rinteCyped Name Sigriabtra` Month Day Year <br /> tY <br /> H <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quan:4 C Type C Residue ❑Partial Rejection ❑Full Rejecton <br /> Manifest Reference Number. <br /> 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> iJ <br /> LL. Facilitys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> ti19.Hazardous Waste Report Maragement Method Codes(Le,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1' f r; ... 1 2. 3. 4. <br /> y• it <br /> 20.Designated Facility Owner or Qperalor:Certification of rece'pt of.hazardous materials covered by the manifest except as noted in Itep 18a <br /> Printed/Typed Name � f Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-65) Previouseditionsare obsolete. DESIGNATED FACILITY'S COPY <br />